ANNUAL REPORT 2018/2019 Andrew L. McCallum President and CEO Message From The CEO In a year which saw a number of key milestones achieved, few of them were as meaningful to Ornge staff and stakeholders as our first-ever Accreditation Canada process.

In October 2018, external surveyors from Accreditation Canada’s Qmentum program visited Ornge’s , Ottawa, Toronto, and London bases, the Operations Control Centre and our head office to assess Ornge against national standards in governance, leadership, medication management, and other areas. Following their review, Ornge successfully received Accreditation with Exemplary standing – the highest possible ranking – under Accreditation Canada’s Qmentum program.

This extraordinary achievement is a testament to the hard work and dedication of the Ornge team. But our first accreditation is only the beginning. We will use the results to improve the quality and safety of our services. Annual Report | Company3 Name

Beyond this milestone, we continue to make considerable progress on our Strategic Plan 2017-2020.

• On our first goal of focusing on activities that improve patient outcomes, we continue to explore, trial and implement technological enhancements such as video larygoscopes, ultrasound and infrascanner into our operation. • For our second goal of improving coordination and integration with system partners, one key project has been the installation of our third generation AW139 helicopter medical interior which allows for seamless integration with the stretcher systems used by the majority of paramedic services across . • Goal three focuses on improving service efficiency and effectiveness. To that end, a number of Operations Control Centre-related improvements, including a new call workflow ensuring calls received go to the right person faster, are now in place. • For our final goal of being a learning and engaged organization, we continue to invest time and resources in unique educational opportunities, including new cadaver lab training, a partnership with Contact North to promote lifelong learning among Ornge staff, and in-house video tutorials for frontline staff.

You can read more about these and many other achievements throughout this report.

I want to conclude by saying what a pleasure it has been for us to reconnect with many of our grateful patients over the past year. Some have come forward to us offering to share their stories in company-wide town hall meetings, in private gatherings with the paramedics and pilots responsible for their transport, or by simply posting a thank you on social media. Two of our past patients have even stepped forward to volunteer as patient representatives on Ornge’s Medical Advisory Committee.

These patients offer a visible reminder of why we are here and the value of our service to the patients of Ontario. As an organization, we are honoured to have played such an important role in ensuring they received timely care.

Andrew L. McCallum President and CEO Table of Contents

Message from the CEO 2

About Ornge 5 Our Services 7 Paramedic Operations 8 Education and Training 10 Aviation 12 Operations Control Centre 14 Health and Safety 16 Awards and Recognition 18 Community, Public and Media Engagement 20 Awards and Recognition 22 The Last Word Goes to Our Patients 22 Financial Stewardship 24 Consolidated Statements of Financial Position 26 Consolidated Statements of Operations 27

The views expressed in the publication are the views of the Recipient and do not necessarily reflect those of the Province of Ontario. Annual Report | Company5 Name

About Ornge A vital part of Ontario’s health care system, Ornge provides high quality air ambulance service and medical transport to people who are critically ill or injured. Ornge services are part of a province-wide system of patient care that links hospitals and communities, enabling access to specialized care for the people of Ontario. A not-for- profit charitable organization, Ornge has more than 600 employees, including paramedics, pilots, communication officers, physicians, aircraft maintenance engineers, along with a team of educators, researchers and support staff. Base Locations Ornge has 12 bases located in 11 communities across the province from which patient care and transportation services are delivered on a 24/7 basis.

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Ottawa Air Base (YQW) Toronto Air Base (YTZ) Sudbury Air Base (YSB) Thunder Bay Air Base (YQT) 1 Leonardo AW139 Helicopter 1 Leonardo AW139 Helicopter 1 Leonardo AW139 Helicopter 1 Leonardo AW139 Helicopter Open 24/7 Open 24/7 Open 24/7 2 Pilatus PC12 Airplanes Open 24/7

Ottawa Land Base (CCLA) GTA Land Base (CCLA) Air Base (YMO) Air Base (YXL) 1 Crestline Land Ambulance 2 Crestline Land Ambulances 1 Leonardo AW139 Helicopter 1 Pilatus PC12 Airplane Open 24/7 Open 12/7 Open 24/7 Open 24/7

C F I London Air Base (YXU) Peterborough Land Base (CCLA) Kenora Air Base (YQK) Air Base (YTS) 1 Leonardo AW139 Helicopter 1 Crestline Land Ambulance 1 Leonardo AW139 Helicopter 1 Pilatus PC12 Airplane Open 24/7 Open 12/7 Open 24/7 Open 24/7 Annual Report | Company7 Name

Ornge Facts Ornge has 12 bases across the province, as well as an administrative Head Office in Our Services .

Ornge’s core business is providing timely patient Ornge also works with Toronto Paramedic transportation involving a range of paramedical Services who deliver critical care land ambulance services, by air and by land, including: services within the GTA and are dispatched by • Emergent and urgent interfacility transport Ornge’s Operations Control Centre. • Emergent scene response • Repatriation of interfacility patients In addition, for many patient transports, Ornge • Non-urgent transport based on geographic and relies on municipal paramedic services for population needs ground transportation between airport and • Support for healthcare in remote communities hospital. Paramedic service partners are crucial through new and innovative approaches to the success of Ontario’s air ambulance • Provincial Transfer Authorization Centre (PTAC) program. authorization in support of public health objective • Transportation related to organ transplant under Ornge Values Mission: contract with the Trillium Gift of Life Network To provide Ontario’s patients with safe and (TGLN), Ontario’s organ and tissue donation timely care, transport, and access to health agency. services. Ornge owns and operates a fleet of fixed and Vision: rotor wing aircraft, including Leonardo AW139 A trusted and responsive partner in extending helicopters, Pilatus PC-12 airplanes, and Crestline the reach of healthcare in Ontario. land ambulances. Service coverage extends over more than a million square kilometres into remote Values: communities in Ontario. In total, approximately Safety, Excellence, Integrity, 20,000 patient-related transports are performed each Preparedness, Compassion. year.

Ornge has contracts with Standing Agreement air carriers who perform fixed wing non-urgent transports and some advanced care transports largely in the North. Paramedic Operations

Paramedic Operations is made up of three departments: Paramedic Support, Paramedic Education and Training, and Professional Standards. Support handles logistics and equipment, Education and Training is responsible for the continual upgrading and skills enhancement of our highly-qualified paramedics, and Standards frames the operational guidelines our medics work within. Annual Report | Company9 Name

Key Achievements:

HeliMods Powered Aero-Loader Stretcher System In November 2018, Ornge announced the procurement of a new Powered Aero-Loader stretcher system from HeliMods, an Australian aerospace technology company. The new system features a self-loading power cot with an equipment bridge which will be able to hold all medical devices in all phases of flight. The system will also allow Ornge to enhance its current bariatric transport capabilities without reconfiguring the aircraft. Ornge took delivery of the first stretcher system in March, 2019.

Interior Layout & Bag Standardization New Video Laryngoscopy Devices After more than a year of committee work and Ornge initiated a process to procure new video frontline consultation processes, Ornge has laryngoscopy equipment for use in the field. A proceeded with the standardization of vehicle number of frontline Ornge paramedics were involved interiors and medical bag layouts. This project and contributed to the evaluation process. The new has been driven by frontline paramedics. There is equipment will replace Ornge’s existing equipment strong evidence, rooted in quality research, that systems. After an extensive testing phase in a standardized equipment and bag layouts reduces risk simulated environment, Ornge procured new video and improves success in high acuity procedures in laryngoscopy devices which entered service in spring the transport environment. It is also a best practice. 2019. Many of the design features in our standardization plan are derived from consultation with other high Ornge Facts performance transport organizations including, Ornge performed over among others, London, United Kingdom Helicopter 20,000 patient related EMS. transports in 2018 Education and Training

The Department of Education and Training at Aeromedical Theory Course that covers all Ornge covers three main areas: aspects of medical air transport.

Initial Education – Advanced Care Paramedic Ornge has a team of highly skilled and – Flight bridge program, and Critical qualified educators to deliver and/or Care Paramedic training -- preparing our coordinate Ornge’s training utilizing a paramedics to perform at high-levels of care combination of self-lead learning and during air transport; instruction from experienced and trained Continuing Medical Education – Annual professionals. Ornge’s educators operate a training and re-certification of our paramedics medium and high-fidelity Patient Simulation so as to maintain that high level of care; Centre which provides Paramedics with an opportunity to perform and practice high risk/ Operational Training – Maintenance of low frequency skills. Patient Simulation is logistical skills such as CPR, Underwater utilized in all aspects of training, except the Escape Training, Lift Testing and upgrading Aeromedical Theory course. knowledge on new equipment; and the Annual Report | Company11 Name

Key Achievements: Ornge Facts Initial Education In 2018, Ornge coordinated over 600 For the period of April 1, 2018 to March 31, 2019, Organ related transports. the Education and Training department has Thats approximately graduated a total of 19 paramedics from its initial 3% of all patient related education programs, 14 of those were Advanced transports. Care Flight Paramedics in the bridge program and five were Critical Care Paramedics.

Continuing Medical Education Four sessions of face-to-face CME were delivered at eight base locations across the province in 2018 for a total of 32 CME sessions.

A total of 16 Paramedics were reintegrated back to Advanced Care Flight or Critical Care Paramedics status as a result of absence from clinical practice. They were absent for reasons such as short term disability, long term disability, parental/maternity leave, etc.

In House First Aid/CPR

CPR training was completed for 20 employees and First Aid/CPR training was completed for 30 employees from the Operations Control Centre, Aviation (including pilots and aircraft maintenance engineers), and Corporate Services. Aviation Ornge’s aviation division is responsible for the operations and maintenance of Pilatus PC-12NG fixed wing aircraft and Leonardo AW139 helicopters, in addition to a robust and approved safety management system (SMS). The holder of two Air Operator Certificates, Ornge aviation employs fixed and rotor wing pilots, aircraft maintenance engineers, managers and support staff. Annual Report | Company13 Name

Key Achievements Ornge Facts Ornge responded to over AW139 Lease/Coverage 1,200 scene calls in 2018.

Ornge acquired an additional AW139 helicopter on a short term lease to provide additional coverage during the medical interior retrofit and other maintenance initiatives.

HeliMods Interior Floor modifications by Ornge’s maintenance team to allow for installation of the HeliMods interior.

Fleet Software Upgrades Installation of Phase 7 software upgrades for the AW139 helicopter fleet.

PC12 Wall Configeration Study Commenced study of the PC-12 wall configuration, with an aim to significantly reduce weight of the aircraft.

Night Vision Goggles Proficiency milestones achieved for Night Vision Goggles (NVG) operations. Operations Control Centre Ornge’s Operations Control Centre (OCC) coordinates all logistics related to Ornge medical transports. The OCC is staffed with Communication Officers who ensure that each medical transport request is assigned the proper medical personnel and equipment in order to provide patients with the best possible care in the most efficient way possible. As Ornge transports critically ill and injured patients across Ontario, time is of the essence. It is the role of the OCC to ensure transport is coordinated in a safe and efficient manner. Annual Report | Company15 Name

Ornge Facts Our Operations Control centre has approximately 45 staff members who Key Achievements work on shifts to provide 24h service.

Ornge Patient Transfer Status Board Provincial Transfer Authorization Centre (PTAC) The Ornge Patient Transfer Status Board is an online As the organization responsible for administration tool, accessible through the Provincial Transfer of PTAC on behalf of the Ministry of Health, the OCC Authorization Centre (PTAC) website, which provides made an important change in the processing of real-time information and updates to stakeholders patient transfer requests in November 2019. regarding their patient transfer.

Short-Term Planning Tool In order to ensure a more secure, efficient and accurate transfer authorization process which The Short Term Planning (STP) Tool was developed better safeguards patient privacy, the OCC began as a theoretical dispatch assist tool by the University accepting transfer requests online exclusively while of Toronto, Human Factors and Applied Statistics decommissioning PTAC requests through fax or Laboratory, Mechanical and Industrial Engineering phone. Department. The STP Tool application is an application created by Ornge IT developers along with Softtech, the developers of Ornge’s Computer Aided OCC Phone Routing Dispatch system, Flight VectorTM. In 2018, the OCC conducted a thorough review of its telephone routing to better enhance service and

The STP Tool provides decision support for efficiency for stakeholders. Using the results of this Communications Officers using historical transfer review, the OCC formulated a new workflow plan and patient data. The tool estimates each interval of to be implemented early in the first quarter of the the overall patient journey in combination with real- 2019/20 fiscal year. time data from various sources. The tool accounts for the nuances of specific transfer routes that With the new workflow, hospital stakeholders are Communications Officers may be less familiar with expected to see a reduction in the amount of time (e.g., the distance between the helipad and hospital, spent on the phone speaking with the OCC and, as a the size of the facility, and differences in in-hospital result, have more time to spend with their patients. time). Health and Safety Occupational Health & Safety

Ornge frontline staff routinely work through challenging circumstances while caring for critically ill or injured patients -- often in isolated environments. As a result, Ornge has taken a number of steps across multiple areas of the organization to provide support for staff through these challenges and to promote wellness, while establishing strategies to ensure a safe and healthy work environment for all. Annual Report | Company17 Name

Ornge Facts Ornge employs over 600 staff members at 13 locations across the province. Key Achievements

Post-Traumatic Stress Disorder (PTSD) Hazard/Incident Reporting

Prevention and Support Program Engaging employees in the identification and An avant garde programme to safeguard the elimination to exposure to risk. Ornge has emotional well-being of our first responders. experienced a significant reduction in severity of accidents over the past 4 years. Employee Survey Ornge successfully implemented our PTSD program, results consistently identify Occupational Health including a Traumatic Incident Review Procedure among the top responses. (TIRP). This procedure focuses on PTSD prevention, Ornge migrated to an online hazard/incident early-intervention, recovery and return to work reporting process with the goal of having a more strategies. The TIRP identifies events that may have efficient and effective way for our employees to the potential to trigger distress in our employees report Occupational Health and Safety (OHS) which results in an operational pause for the effected workplace hazards and incidents. This online platform crew(s). This program was designed to provide a brings OHS reporting in line with both Ornge’s safe and secure workplace for our employees and Paramedicine and Aviation Safety teams. All three includes practices geared towards the prevention of departments collaborate to continue to improve the PTSD and maintenance of mental health. ease of reporting for our staff. Early identification and investigation is the key to preventing injury and Job Hazard Analysis/Profiles illness. Safeguarding the physical well-being of employees by scrutinizing each individual job classification for identification and exposure to risk. In consultation with worker health and safety representatives and frontline staff, a re-evaluation of all frontline positions was conducted to identify potential hazards associated with daily work. During the analysis, focus was placed on job tasks as a way to identify hazards before they occur and/or mitigate the risk of any existing workplace hazards by implementing safe control measures for the protection of our employees. Awards and Recognition

Telecommunicactor of the Year Award: Bruce Hecker

Telecommunicator of the Year Ornge presented its second annual Telecommunicator of the Year Award during National Telecommunication Public Safety Week in April. This year’s recipient is Bruce Hecker, Communications Officer – Medical. Annual Report | Company19 Name

Life Saved Award Governor General Award: Dan Duguay

Life Saved Awards Governor General Each year, Ornge presents its first Life Saved Exemplary Service Medal Awards. A lightning bolt pin, representing life, is The Emergency Medical Services Exemplary Service presented to Ornge teams (including paramedics, Medal recognizes professionals in the pre-hospital pilots, communications officers and physicians) who emergency medical services industry who have have worked together to successfully ensure the performed their duties in an exemplary manner, resuscitation of a patient who was ‘vital signs absent’ characterized by good conduct, industry and in the field. This year’s recipients: efficiency.

1. Ottawa Crew All recipients must have been employed with an Paramedics: Heather Stirling, Anne-Marie Piche emergency medical service on or after October 31, OCC: Mark Barrett, Doug Davis 1991 and have completed 20 years of exemplary Transport Medicine Physician: Doug Chisholm service.

2. Timmins/Sudbury Crew This year, three Ornge paramedics were honoured: Paramedics: Melissa Roney, Mathieu Coulombe • Nicole Izsak – Paramedic Education Specialist Pilots: Glenn Collier, Jordan Rowland • Paul Richard – Paramedic Education Specialist OCC: Tanya Power-Whalen, Justin Phillips • Ray Dewar – Critical Care Paramedic, Ottawa Transport Medicine Physician: Anna Gunz

In addition, Dan Duguay, an Ornge Thunder Bay 3. Thunder Bay Staff Critical Care Paramedic, received his 30 year bar. Awarded for actions conducted off-duty Paramedic: Anik Malabossa Community, Public and Media Engagement

Ornge continues to believe engaging with communities across Ontario is essential to creating positive interactions with the people we serve. Through events, social and traditional media, we seek to provide educational opportunities about our services for stakeholders, community leaders, potential future employees and members of the general public.

Ornge maintains a visible digital presence on digital and social media where information about our service is accessible to all Ontarians. Whether we are promoting safety on Ontario’s roads, waterways or trails, or keeping communities up to date with unfolding operational responses, Ornge strives to provide information for public benefit on a regular basis.

Key Achievements

Landing Zone Safety Video Air Ambulance Golf Classic The safety of the general public, first In 2018, Ornge’s Air Ambulance Golf Classic responders and healthcare providers when partnered with Outward Bound Canada to raise operating around an Ornge helicopter is funds for Indigenous programming supporting paramount. Ornge created and released an women and youth. Thanks to the support of updated version of its Landing Zone Safety Ornge staff and stakeholders who participated, Video which highlights: $15,000 was raised towards these programs. • How first responders and healthcare providers can prepare themselves for an Ornge helicopter landing and departure Patient Stories • Choosing, preparing and securing a landing Leveraging the power of social media and the site • Expectations for helicopter arrival and community, Ornge frequently engages with departure • Approaching and leaving the helicopter patients and their families. In 2018, Ornge utilized • Night Operations these platforms to seek out six patients and their • Communication directly with the flight crew families to participate in video interviews to share This video was distributed to Police, Fire their stories with us. Patient stories continue to and Paramedics Services and healthcare demonstrate the work of Ornge’s crews and are providers in Ontario for review to ensure viewable on our website and social platforms. their safety around an Ornge helicopter. Annual Report | Company21 Name

London Air Show Toronto Pride

Community Engagement Media Partners Throughout the year, Ornge receives many requests The media plays an important role in educating to attend events in communities across the province. Ontarians about Ornge operations across the In the past year, we’ve participated in and hosted a province. News outlets are important partners in number of events and campaigns including: sharing our key messages of safety. • All Canada Aeromedical Transport (ACAT) Safety Notable News Stories Conference • Bell Let’s Talk Campaign • Canada Day celebrations at the Canada Aviation and Space Museum • Careers in Aviation Career Fair • CTV and the Salvation Army’s Toy Mountain Christmas toy drive Breakfast Television • Doors Open Toronto In October, 2018, City’s Stella Acquisto from • International Air Ambulance Week Breakfast Television in Toronto spent a morning • International Nursing Week with Ornge to learn more about our fixed-wing • Kenora Emergency Services Safety Night operation and interoperability with partners in • KinderMedic, a one day workshop hosted by care such as Toronto Paramedic Services. Ornge’s Paediatric Team

• Air Ambulance Golf Classic • Paramedic Services Week • Take Your Kids to Work Day • National Telecommunication Public Safety Week • The Canadian Paramedic Memorial Ride • Toronto Sportsmen’s Show Air response: Anatomy of a MCI In an effort to provide insight into how Ornge To collaborate with Ornge for a health or awareness operates in the event of a mass casualty incident campaign, or to invite us to an event, please contact (MCI), Hospital News published an article detailing us using [email protected]. Ornge’s response to an MCI in Stayner, Ontario. The Last Word Goes to our Patients

On June 21, 2018, 2 1/2 month old Lucas Tanswell arrived to Kingston General Hospital with heart failure. Lucas’s parents Milton and Anne-Marie share their story.

I awoke at 4 a.m. to my infant son fussing as normal. He wouldn’t nurse and was hard to console. We kept him calm for the morning trying to figure out what was wrong. He was healthy, developing well, happy.

On the morning of June 20, our seemingly healthy 2 1/2 month old son Lucas was in heart failure. The events that followed truly saved his life. After visiting our family doctor we were sent to Urgent Care then taken by ambulance to Kingston General Hospital and afterwards airlifted to SickKids. Annual Report | Company23 Name

Lucas was stabilized in Kingston and the team originally informed us that we were going to Ottawa. About an hour before we were set to leave I was told we were now going to be going to Toronto as they could better suit his needs.

Lucas was diagnosed with Dilated Cardiomyopathy. It was imperative that he make it to SickKids to undergo treatment, care and potentially a heart transplant in the cardiology Watch the video online at: department there. www.vimeo.com/showcase/orngepatients It took a few days for everything to settle in, but when I look back on the events of that day, I know how important the care of hospital staff and paramedics truly saved his life.

Lucas’ helicopter ride and the gentlemen who looked after my boy will never be forgotten. Their continuous, watchful care kept him stable so he could arrive safely that night. They were kind and considerate offering explanations and information as the flight went on.

His Flyin’ Lion, given to me as we exited the helicopter on the roof of SickKids as a memento, has not left his side and we look at it as his good luck charm. I often draped it beside his head as he sleeps to comfort him, especially those nights in Critical Care when we couldn’t be beside him.

Ornge, you were a crucial step in saving Lucas’ life. We will never ever forget this and we are thankful that we live in a place where having the proper care isn’t a privilege, it is a right.

I used to be sad when I saw that Ornge helicopter in flight but now I look at it with gratitude and hope.

We’re very pleased to report that Lucas has successfully received a heart transplant in January, 2019 and is now home with his family. Financial Stewardship Total funding received by Ornge in fiscal 2018/19 included $188.6 million from the Ministry of Health (inclusive of annual funding and one-time funding) for air and Critical Care Land Ambulance services, as well as $5.0 million from Trillium Gift of Life Network for transporting organs and transplant surgical teams.

We continue our mission of providing patients with the safe and ready access to healthcare by the most efficient means. Maintaining our operation with fiscal discipline to ensure public funds entrusted to us are utilized effectively remains a cornerstone of Ornge’s strategic plan. Rising operating cost of our fleet, fluctuating fuel prices, changing labour markets and service cost of our legacy debt obligations are some of the challenges we had to address and will continue to manage in the coming year.

By leveraging innovative solutions, our resourceful staff, and through collaborations with Ontario healthcare partners, we are making advances in our long term strategic goals while laying a solid and sustainable financial foundation for the future. Annual Report | Company25 Name

Key Achievements

Standing Agreement Carriers OPERATING EXPENSES Negotiated new Standing Agreement Carriers — by area contracts to optimize asset deployment.

Notes Long Term Maintenance Program The charts illustrate the components of Ornge’s Entered into AW139 engine long term operating expense and the percentage of each component to total annual operating expenses for the maintenance program. most recent and prior fiscal year.

IT Infrastructure 43% 43% 40% 40% Strengthen IT infrastructure to both expand capacity and raise resilience to threats.

9% 9% 8% 8%

2018/19 2017/18

Definitions

Labour: salary, employee benefit and other labour related expenditures.

Aviation: cost for fleet operation including aircraft maintenance, fuel, and standing agreement carriers.

Other Operations: medical supplies, facilities, administrative support expenses.

Specifically Funded Programs: Critical Care Land Ambulance Program Consolidated Statement of Financial Position (in thousands of Canadian dollars)

March 31, 2019 March 31, 2018

ASSETS

Cash $4,416 $2,458

Other current assets 40,531 18,306

Current assets 44,947 20,764

Restricted cash 400 400

Maintenance contract 21,419 24,980

Capital assets 179,156 177,603

Total assets $245,922 $223,747

LIABILITIES

Short-term loan $24,000 $8,100

Accounts payable and other short-term liabilities 26,630 24,744

Current portion of long-term debt 9,747 9,213

Current liabilities 60,377 42,057

Long-term debt 236,273 245,860

Long-term maintenance contract 8,512 11,980

Total liabilities 305,162 299,897

Net deficiency (59,325) (76,714)

Unrealized remeasurement gains 85 564

Total liabilities and net deficiency $245,922 $223,747 Annual Report | Company27 Name

Consolidated Statement of Operations (in thousands of Canadian dollars)

2019 2018

REVENUES $217,164 $195,024

EXPENSES

Labour-related expenses 74,346 72,826

Aviation and other operating expenses 98,897 95,521

173,243 168,347

EXCESS OF REVENUES OVER EXPENSES BEFORE OTHER EXPENSES 43,921 26,677

Amortization and other 11,170 10,896

Interest expense 15,362 16,006

SURPLUS OF REVENUES OVER EXPENSES $17,389 $(225)

Net deficiency, beginning of the year (76,714) (76,489)

NET DEFICIENCY, END OF THE YEAR $(59,325) $(76,714)

Ornge Facts Ornge performed over 19,000 interfacility transports in 2018. Ornge

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